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Posted by on Feb 28, 2021 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

The authors compared a high-dose radiation (24 Gy) in 12 parts with a low-dose radiation (4 Gy) in 2 parts in patients with slow-growing non-Hodgkin lymphomas (NHLs).

The study found that the best radiotherapy dose for slow-growing NHLs is 24 Gy in 12 parts after a 5-year follow-up.

Some background

The current standard of care for slow-growing NHL such as follicular lymphoma (FL) or marginal zone lymphoma (MZL) is 24 Gy in 12 sessions. However, some small studies showed that a smaller dose of radiations of 4 Gy in two sessions may offer the same effectiveness in the short-term.  

The best radiotherapy dose for slow-growing NHLs in the long-term remains uncertain.

Methods & findings

548 patients with slow-growing NHL (FL and MZL) were included in this study. They were randomly divided in to two groups to receive either 24 Gy in 12 fractions or 4 Gy in 2 fractions. The average follow-up time was 73.8 months.

After 5 years, 89.9% of the 24 Gy group were alive without disease worsening compared to 70.4% in the 4 Gy group. Patients who received 24 Gy were 3.46 times more likely to have better survival without cancer worsening after 5 years.

In patients with MZL, 100% were alive without cancer worsening after 5 years in the 24 Gy group compared to 88% in the 4 Gy group. In patients with FL, 88.2% of the 24 Gy group were alive after 5 years without cancer worsening compared to 67.5% of the 4 Gy group.  

There was no difference in overall survival between groups. The 5-year overall survival rates were 75.1% in the 24 Gy group and 77.6% in the 4 Gy group.

Medium to severe side effects were reported in 10% of patients in the 24 Gy group and 4% of the 4 Gy group. The most common side-effects were hair loss, dry mouth, fatigue, mouth sores, and pain. 

The bottom line

This study showed that 24 Gy in 12 sessions was the most effective, tolerated treatment for patients with slow-growing NHLs in the long-term.

Published By :

The Lancet. Oncology

Date :

Feb 01, 2021

Original Title :

4 Gy versus 24 Gy radiotherapy for follicular and marginal zone lymphoma (FoRT): long-term follow-up of a multicentre, randomised, phase 3, non-inferiority trial.

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